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Clinical Features and Outcome of Refractory Status Epilepticus Patients in an Eastern Indian Tertiary Care Hospital

Suman Das , Kartik Chandra Ghosh1 , Ramesh Bhattacharya2 , Saikat Ghosh3 , Sarbajit Das4 , Suman Das5 , Hema Krishna Pattem6 , Gourango Prosad Mondal7

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International Journal of Neurology and Neurosurgery 11(1):p 5-12, January-March 2019. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11119.1

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Abstract

 Introduction: Refractory status epilepticus is defined as the status epilepticus which is refractory to two intravenous anti-epileptic drugs, one of which is a benzodiazepine. RSE occurs in 23–43%, this progression being time dependent with early management being advocated to achieve control. Methods: The study included the adult patients of convulsive refractory status epilepticus admitted at the Neurology, General Medicine and Surgical intensive treatment units of Calcutta National Medical College, Kolkata, between 1st January to 31st August 2018. The patient’s demographic data, medical history, treatment received and outcome were documented. We titrated all the drugs to the suppression of the seizure activity. The data are presented according to the treatment type [general anesthesia and antiepileptic drugs], and according to the outcome [favorable (modified Rankin Score or mRS<2), and unfavorable (mRS≥2)] and analyzed by univariate and subsequent multivariate analysis. Statistical analysis was done using SPSS version 22.0 software. Results: 24 patients were included in the study, 62.5% being males. Inflammatory central nervous system diseases followed by stroke were the commonest causes of convulsive refractory status epilepticus. Mortality rate was 25% and 41.67% had the favorable outcome. Multivariate analysis identified complex partial status epilepticus [Adjusted Odds Ratio=7.6 (95% CI=1.5-54.4), p=0.04], partial onset seizures [Adjusted Odds Ratio=9.8 (95%CI=1.4-69.34), p=0.034 and hyponatremia [Adjusted Odds Ratio=7.7 (95% CI=1.32-53.37), p=0.037) as the factors responsible for failure of control of convulsive refractory status epilepticus by antiepileptic drugs alone. The need for GA was associated with unfavorable outcome [Adjusted Odds Ratio=11.7 (95% CI=1.22-125.31), p=0.037]. Patients with lower Glasgow coma score and higher Status Epilepticus Severity Score at the time of admission in intensive treatment units, those with longer time being elapsed between seizure onset and hospital admission had significant higher incidence of need for general anaesthesia and the unfavorable outcome. Conclusion: The etiology of convulsive refractory status epilepticus does not affect the refractoriness and outcome, which are more dependent on the Glasgow coma score, Status Epilepticus Severity Score at admission and the time gap between seizure initiation and hospital admission.

Keywords: Epilepticus Severity Score; hyponatremia; modified Rankin Score.

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.11119.1

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